Minimally Invasive versus Open Mitral Valve Surgery a Consensus Statement of the International Society of Minimally Invasive Coronary Surgery (ISMICS) 2010

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The purpose of this consensus conference was to deliberate the evidence regarding whether minimally invasive mitral valve surgery via thoracotomy improves clinical and resource outcomes compared with conventional open mitral valve surgery via median sternotomy in adults who require surgical intervention for mitral valve disease. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Before the consensus conference, the consensus panel reviewed the best available evidence up to March 2010, whereby systematic reviews, randomized trials, and nonrandomized trials were considered in descending order of validity and importance. The accompanying meta-analysis article in this issue of the Journal provides the systematic review of the evidence. Based on this systematic review, evidence-based statements were created for pre-specified clinical questions, and consensus processes were used to derive recommendations. The American Heart Association/American College of Cardiology system was used to label the level of evidence and class of each recommendation. </jats:p></jats:sec><jats:sec><jats:title>Results and Conclusions</jats:title><jats:p> Considering the underlying level of evidence, and notwithstanding the limitations of the evidence base (retrospective studies with important differences in baseline patient characteristics, which may produce bias in results of the evidence syntheses), the consensus panel provided the following evidence-based statements and overall recommendation: In patients with mitral valve disease, minimally invasive surgery may be an alternative to conventional mitral valve surgery (Class IIb), given that there was comparable short-term and long-term mortality (level B), comparable in-hospital morbidity (renal, pulmonary, cardiac complications, pain perception, and readmissions) (level B), reduced sternal complications, transfusions, postoperative atrial fibrillation, duration of ventilation, and intensive care unit and hospital length of stay (level B). However, this should be considered against the increased risk of stroke (2.1% vs 1.2%) (level B), aortic dissection (0.2% vs 0%) (level B), phrenic nerve palsy (3% vs 0%) (level B), groin infections/complications (2% vs 0%) (level B), and, prolonged cross-clamp time, cardiopulmonary bypass time, and procedure time (level B). The available evidence consists almost entirely of observational studies and must not be considered definitive until future adequately controlled randomized trials further address the risk of stroke, aortic complications, phrenic nerve complications, pain, long-term survival, need for reintervention, quality of life, and cost-effectiveness. </jats:p></jats:sec>

Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation: A propensity-matched comparison

“…The recent consensus statement from the International Society of Minimally Invasive Coronary Surgery assigned a class IIb recommendation for minimally invasive surgery for mitral valve disease. 21 The present study affirms the noninferiority of minimally invasive mitral valve surgery via right minithoracotomy. Although procedure time is lengthened, risks are comparable or less, transfusions are less frequent, duration of ventilatory support is similar, hospital length of stay is equivalent, and long-term survival is similarly excellent.…”

Mitral Valve Replacement—Current and Future Perspectives

“…33–35 However, the current device costs in an unfavorable economic climate, in addition to significant learning curves in an era of uncompromising quality control, limit its application to centers of excellence with established experience. The technical setup of endoscopic port access surgery is well described.…”

Minimally invasive mitral valve replacement is a safe and effective surgery for patients with rheumatic valve disease

“…[3,4] Its prominent advantage in postsurgery recovery and the small incision required makes patients prefer it over a traditional incision. [4,5] However, dispute still exist regarding the safety of a MI approach. [6] Furthermore, due to the low prevalence of rheumatic valve disease in the western world, few articles have focused on patients with rheumatic fever.…”